week 26 · last reviewed 2026-08-09
Lisfranc surgery recovery: week 26
Clinical procedure: Lisfranc injury surgery (fixation or fusion).
what's typical at week 26
Is pain at week 26 of lisfranc surgery recovery normal?
typical pain · week 26
Across published cohorts, typical pain around week 26 of lisfranc surgery recovery sits at 2.2/10 (range 1.5–2.8). This week was measured directly in the cited cohort. Typical, evidence-anchored estimate only. It is not medical advice, not a prediction for your body, and not a substitute for your surgeon or clinician.
Measured week · 1 study · Pain and midfoot function after joint-sparing suture-tape augmented Lisfranc fixation (n=58, mean 16.9-month follow-up) (retrospective case series)
weeks 12–26
Weeks 12-26 · the first measured numbers, and hardware
Three months is where measurement finally starts. In a group of 58 people followed after joint-sparing fixation, average pain on a 0 to 10 scale was 3.6 at three months and 2.2 at six months, down from 5.3 before surgery. Midfoot function on a 0 to 100 scale, where higher is better, moved from 28 before surgery to 69 at three months and 80 at six months.
Hardware removal usually falls inside this window when it happens at all. In a cohort of 482 patients it came at a mean of 4.43 months, about nineteen weeks. In a smaller group of 39 purely ligamentous injuries it came at a mean of about four months, with individual cases spread between roughly twelve and thirty two weeks, and two out of three people had it done. In the 482-patient cohort, physical function scores after removal were higher than in people whose hardware stayed in, by 5.6 points.
Full activity, in the 73-person cohort, arrived at four to five months after surgery, which is roughly weeks seventeen to twenty two. A separate series of 15 people treated with a suture-button device measured the steps rather than prescribing them: weight-bearing as tolerated came at an average of 6.6 weeks, and return to work or play as tolerated at an average of 14.1 weeks, each with a spread of a few weeks either side.
documented at this week
This week
The long middle of the first year
This is the stretch where change is real but slow enough to miss day to day. In a group of 58 people followed after joint-sparing fixation, average pain on a 0 to 10 scale was 2.2 at six months, down from 3.6 at three months. The distance between those two numbers took five months to cover.
Good to know
Hardware removal often comes months after surgery
Among people who had a Lisfranc ORIF and later needed the hardware taken out, removal happened an average of 4.4 months after the original surgery. Physical-function scores recorded afterward were measurably higher than in people whose hardware stayed in place, consistent with hardware irritation surfacing as a mid-recovery setback rather than a lasting one.
What's typical
Wound infection differs by how the surgery was done
In a matched analysis of 1,100 people per group, surgical site infection within 90 days was recorded in 2.1 percent after open fixation and 4.5 percent after percutaneous treatment. Transfusion was also less common after open fixation, at 1.0 percent against 2.1 percent.
What's typical
Whether hardware comes out depends on the operation
Across a 25-study meta-analysis of ligamentous Lisfranc injuries, hardware removal happened in 86 percent of patients fixed with open reduction and internal fixation, compared with 22.5 percent after primary arthrodesis and 0 percent after flexible fixation. Whether that later removal phase happens at all tracks closely with which surgery was done.
What's typical
Reoperation odds differ sharply by procedure in bony injuries
In a randomized trial of tarsometatarsal fracture dislocations, the bonier end of the Lisfranc spectrum, 78.6 percent of the screw and plate fixation group went on to a planned or unplanned second surgery, compared with 16.7 percent of the primary fusion group. Physical function scores on the SF-36 and SMFA questionnaires did not differ significantly between the two groups through 24 months, and satisfaction ratings matched at an average of 53 months.
The pattern
Pain drops fastest in the first three months
In a group of 58 people who had joint-preserving surgical fixation for a Lisfranc injury, average pain on a 0 to 10 scale fell from 5.3 before surgery to 3.6 at 3 months, 2.2 at 6 months, and 1.5 at 12 months. Most of the drop happens early, with smaller, steady gains continuing through the rest of the first year.
The pattern
Midfoot function keeps climbing through year one
In the same group of 58 people, AOFAS midfoot function scores, on a 0 to 100 scale where higher is better, rose from an average of 28 before surgery to 69 at 3 months, 80 at 6 months, and 90 at 12 months. Function continues building well past the early weeks, not just in the first quarter.
Coming up
Training returns before competition does
A review of Lisfranc injuries in sport places return to training at 18 to 24 weeks and return to competitive play at 21 to 31 weeks. Across pooled studies, 93 to 94 percent of athletes returned to some level of sport and 74 to 88 percent reached their pre-injury level. Athletes with ligamentous injuries returned nearly four weeks earlier than those with bony injuries.
Coming up
Hardware removal averages about four months after fixation
In a cohort of 482 Lisfranc ORIF patients, the hardware that eventually came out was removed at an average of 4.43 months after surgery, close to nineteen weeks. Among those patients, physical function scores measured after removal were higher than scores taken beforehand.
Coming up
In ligamentous injuries, hardware removal timing varies widely
In a group of 39 feet with purely ligamentous, stage two Lisfranc injuries, hardware removal happened at an average of about four months after surgery, roughly seventeen weeks, with individual cases ranging from about twelve to thirty two weeks. Two out of three people in this group ended up having that second procedure.
Back to work
Return to work or play averages fourteen weeks
In the same series of 15 people, the average time to return to work or play as tolerated was 14.1 weeks, with a spread of about 3.6 weeks either side. That places the middle of the range at roughly three and a half months, and the wider range from about ten weeks to eighteen.
Back to work
The harder injury returned to work sooner, not later
In a prospective study of 32 people, all 21 with high-energy injuries had resumed their pre-injury work by six months, while 3 of the 11 with low-energy injuries had not. Pain at six months told a similar story: the high-energy group fell from 8 to 2 on a 0 to 10 scale, the low-energy group from 6 to 3. Severity at the moment of injury does not settle where you finish.
sources
What this page is built from
- Pain and midfoot function after joint-sparing suture-tape augmented Lisfranc fixation (n=58, mean 16.9-month follow-up) retrospective case series · reliability 6/10
- Primary arthrodesis versus open reduction internal fixation for acute Lisfranc injuries: systematic review and meta-analysis (18 studies) meta-analysis · reliability 9/10
- Primary arthrodesis versus ORIF for Lisfranc injuries: meta-analysis of 5 randomized trials (241 patients) meta-analysis · reliability 9/10
- Return to play after low-energy Lisfranc injury: systematic review and meta-analysis (441 athletes and active-duty personnel) meta-analysis · reliability 8/10
- Flexible fixation versus ORIF versus primary arthrodesis for ligamentous Lisfranc injuries: meta-analysis (25 studies) meta-analysis · reliability 8/10
- Do Lisfranc ORIFs fail? Long-term conversion to arthrodesis in 8,101 patients at 5 and 10 years retrospective cohort · reliability 8/10
- Hardware removal after Lisfranc ORIF: timing and patient-reported outcomes (482 patients, 489 feet) retrospective cohort · reliability 8/10
- Primary arthrodesis versus ORIF for Lisfranc injuries: comparative cohort with rehabilitation protocol (73 patients) retrospective cohort · reliability 7/10
- Ligamentous Lisfranc injuries: hardware removal timing and rate (39 feet, stage II) retrospective case series · reliability 6/10
- Outcomes of Lisfranc injuries in active-duty service members (n=70, mean 3.5-year follow-up) retrospective case series · reliability 6/10
- Ly and Coetzee: treatment of primarily ligamentous Lisfranc joint injuries, primary arthrodesis versus ORIF (randomized, n=41) randomized trial · reliability 8/10
- Henning et al.: open reduction internal fixation versus primary arthrodesis for Lisfranc fracture-dislocations (randomized, n=40) randomized trial · reliability 8/10
- Early outcomes of Lisfranc injuries treated with a suture-button internal brace (case series, n=15) case series · reliability 6/10
- High- and low-energy Lisfranc injuries: prospective functional outcomes and return to work at 6 months (n=32) prospective case series · reliability 6/10
- Lisfranc sports injuries: review of return-to-training and return-to-competition windows narrative review · reliability 6/10
- Postoperative complications of percutaneous versus open treatment of Lisfranc injuries (matched, 1,100 per cohort) retrospective cohort · reliability 8/10
- Functional outcomes of open reduction and internal fixation for Lisfranc injuries (n=87, mean 4.9-yr follow-up) retrospective case series · reliability 6/10
- Mid- and long-term consequences after surgically treated Lisfranc injuries (14 followed, mean 8.3 yr) case series · reliability 6/10
- Week-by-week postoperative protocol after Lisfranc fixation in athletes (case series, 10 followed) case series · reliability 6/10
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